Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance


Document Information
  How to complete a fillable form.
Title Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance
Document number F242-173-333
How to get this document
Alt Language(s) Español
Valid dates 10/2008
Contact information Claims for Job Injuries , Managing Injured Workers' Claims
Websites Workers' Comp Claims

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